Pregnancy planning in fellowship

[DoctorStrange0101]

Hi all! I’m a third year FM resident doing a one year surgical OB fellowship next year. I am getting older and my husband and I want multiple kids (probably 3+). I’ll be 30-31 during fellowship year. The fellowship schedule is strenuous (q2 home call for c-sections, one 30 hour call monthly, one period of working two weeks on per month). It’ll be stressful—new city, new skills, new responsibilities. But, I need to start trying for a baby soon before it’s too late. My top priority is having a family, followed by my medical career. I’d never forgive myself if I was unable to get pregnant due to waiting too long. Ideally, I could get pregnant during fellowship, but I’m worried about the physical demands of the job. I also am not sure how to time things. I’ll need to search for a job after fellowship and if the stars aligned and timing worked out I could have the baby between fellowship and new job and then start new job after time off for maternity leave. However, I realize this may not work. What do you think in terms of timing pregnancies? I imagine it’d be hard to find an attending job if I’d be delivering soon after starting, right? Please help! This is super stressful.

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[Bronze Medal]

There’s no perfect time and all of these options are doable. All things being equal I would err on the side of trying earlier because you never know if sub-fertility or infertility will be an issue for you.

 

[togaedere]

Completely agree with above. There are no guarantees with this. I was a non traditional resident and had my first kid in residency at the age of 38 and am pregnant with my second in my first year of attendinghood at the age of 40. Granted I’m not in a surgical field but being pregnant during training sucks but you do your best. I had some minor fertility issues and suffered a loss as well so it really is about starting to try and working it out from there. You are young also, so you likely have lots of fertile time left tho I do have colleagues who have had to go down the IVF route as well. Trying now allows you to figure out what you’d need going forward and what to prepare for. Theres no ideal time.

 

[AMEHigh]

With fellowship being only 1 year I probably personally wouldn’t try to get pregnant during fellowship. You’ll have doctor’s appointments and then you never know if you might need to take unexpected time off plus you don’t want to be rushed after having the baby. I know you said family is important but if you’re doing the fellowship you might as well get the most out of it.

So I would start trying mid-way through fellowship. And just a reminder that there are other practical things to consider too such as health insurance and not having enough leave saved up for paid maternity leave that you can consider as well.

30 is still young so most likely things will be fine!

 

[Alyssum]

If you're starting a new job as an attending, would you have enough/any paid maternity leave accrued to be able to stay off of work for a while?

 

[Bronze Medal]

If you're starting a new job as an attending, would you have enough/any paid maternity leave accrued to be able to stay off of work for a while?

This is definitely a consideration. Most places offer 6 weeks of FMLA, but you have to have worked for the employer for 1 year prior. Other employers also offer a separate “parental leave.” At my place of work this is an additional 6 weeks of paid leave. So between FMLA and parental leave, employees here could take 12 weeks of paid leave. Vacation and sick days could also be used if you didn’t qualify for FMLA, but if you haven’t worked somewhere very long then you won’t have accrued many of these. The last option is to take unpaid leave for any additional time you want to take off.

 

[Alyssum]

^Good to know the options, thanks!

 

[rokshana]

This is definitely a consideration. Most places offer 6 weeks of FMLA, but you have to have worked for the employer for 1 year prior. Other employers also offer a separate “parental leave.” At my place of work this is an additional 6 weeks of paid leave. So between FMLA and parental leave, employees here could take 12 weeks of paid leave. Vacation and sick days could also be used if you didn’t qualify for FMLA, but if you haven’t worked somewhere very long then you won’t have accrued many of these. The last option is to take unpaid leave for any additional time you want to take off.

however, as a fellow, ACGME time off trumps any hospital/facility policies. Generally you can only have 4 weeks off for any reason/year of training otherwise you may have to extend training.

 

[gutonc]

however, as a fellow, ACGME time off trumps any hospital/facility policies. Generally you can only have 4 weeks off for any reason/year of training otherwise you may have to extend training.

For longer fellowships (Cards, GI, Hem-Onc, PCCM) this is less of an issue as you can easily work around this with research and other electives. But yes, for 1 and 2 year fellowships, this can be a concern.

 

[sunshinefl]

ABIM Clarifies Leave Policies Intended to Support Resident Physicians | ABIM.org

ABMS Announces Progressive Leave Policy for Residents and Fellows

CHICAGO – July 13, 2020—The American Board of Medical Specialties (ABMS), the leading not-for-profit organization that oversees physician certification in the...

www.abms.org

https://med.stanford.edu/content/dam/sm/gme/wim/resources/research/Misinterpretation-of-the-American-Board-of-Internal-Medicine-Leave-Policies-for-Resident-Physicians-Around-Parental-Leave.pdf

It’s 5 weeks/35 days per year, with an additional 35 days. So in a 3 year IM residency, you can miss 140 days total.

not sure how it applies to OP with a 1 year fellowship not in IM, but I’m going into IM so that’s what I’m familiar with, and figured I would put the links here for other readers.

 

[Bronze Medal]

however, as a fellow, ACGME time off trumps any hospital/facility policies. Generally you can only have 4 weeks off for any reason/year of training otherwise you may have to extend training.

Sure, this is something to take into consideration. However, in the grand scheme of things extending training by a few weeks is not a big deal for most people. I extended residency by a few weeks and started fellowship late. I knew this would be the case and disclosed it on all of my fellowship interviews. It was a little inconvenient for my fellowship program, but they were understanding.

 

[rokshana]

ABIM Clarifies Leave Policies Intended to Support Resident Physicians | ABIM.org

ABMS Announces Progressive Leave Policy for Residents and Fellows

CHICAGO – July 13, 2020—The American Board of Medical Specialties (ABMS), the leading not-for-profit organization that oversees physician certification in the...

www.abms.org

https://med.stanford.edu/content/dam/sm/gme/wim/resources/research/Misinterpretation-of-the-American-Board-of-Internal-Medicine-Leave-Policies-for-Resident-Physicians-Around-Parental-Leave.pdf

It’s 5 weeks/35 days per year, with an additional 35 days. So in a 3 year IM residency, you can miss 140 days total.

not sure how it applies to OP with a 1 year fellowship not in IM, but I’m going into IM so that’s what I’m familiar with, and figured I would put the links here for other readers.

This new though right? It’s not effective this year...though I guess for those applying this year, it would apply...nice to see that they are giving consideration for family leave.

 

[rokshana]

Sure, this is something to take into consideration. However, in the grand scheme of things extending training by a few weeks is not a big deal for most people. I extended residency by a few weeks and started fellowship late. I knew this would be the case and disclosed it on all of my fellowship interviews. It was a little inconvenient for my fellowship program, but they were understanding.

You’re right, in the grand scheme it really isn’t a big deal, but there will be people who look for these longer PTO/sick leave and then will be surprised that in the end doesn’t apply to them without extension of training.

 

[MarkDe]

In our department. Yesterday a 52-year-old woman was admitted to conservation in the 4th trimester, she and her husband completed full training in four weeks and were successfully discharged, they had no children before.
All conditions depend on the person and the degree of preliminary preparation is similar.

 

[gutonc]

In our department. Yesterday a 52-year-old woman was admitted to conservation in the 4th trimester, she and her husband completed full training in four weeks and were successfully discharged, they had no children before.
All conditions depend on the person and the degree of preliminary preparation is similar.

What is this nonsense?

 

[futuredo32]

As someone who waited until the time was right, there is no right time. I waited so long for the right time, I am now on a list for donor embryos for IVF. Good luck and baby dust to you

 

[bikelady]

In a perfect world, as you said, you could time your pregnancy so you will deliver the day after your graduate fellowship and delay your start date for your job until you have taken a suitable maternity leave. We do not live in that world, unfortunately. There is no "ideal" time to have a baby. I had one in residency and it was miserable, I took 3 weeks off before going back to work and my program was not very supportive of trying to breastfeed, or of being a new parent in general. I had my 2nd baby as a 2nd year attending when I still had a salary guarantee and although I went into a small amount of "debt" (so I did not get a bonus that year, but over time made it back up so when I became a partner in my group, I didn't owe anything.) It was much better, but I was older and having a 2nd baby at 37 years old. I would not have wanted to wait to start my family then.

Only a truly toxic group will take issue with you being pregnant/newly postpartum and you don't want to be there anyway. I interviewed with my partners when I was 37 weeks pregnant. No hiding that from a bunch of obstetricians! However as someone else mentioned, FMLA does not kick in for a year and you may not be eligible for paid leave at all as an attending. Now, even though you do not qualify for FMLA doesn't mean your group won't grant you a decent maternity leave, but may be something to consider.

You do not now know what your attending job will look like, whether you will be able to take any paid leave, if so for how long, how long unpaid you can take, etc. You are still fairly young but in general with fertility, the sooner the better.

In terms of the demands of your schedule, pregnancy is different for every woman. I and my residency colleagues all worked full schedule/call until we delivered (I actually front-loaded my calls that year so when I came back after mat leave I didn't have to pay anyone back) and it was a non-issue. I wouldn't worry about being pregnant during fellowship. Being postpartum is another thing entirely - will you get adequate leave, and will you have to extend your training?

Above all be honest and up front with people - with your program director, Co-fellows, everyone. This is not to say you need to share the details of every pregnancy attempt but I recommend you tell your program (or job) by the end of the first trimester so plans can be made.

Good luck!

 

[Nata Herman]

In a perfect world, as you said, you could time your pregnancy so you will deliver the day after your graduate fellowship and delay your start date for your job until you have taken a suitable maternity leave. We do not live in that world, unfortunately. There is no "ideal" time to have a baby. I had one in residency and it was miserable, I took 3 weeks off before going back to work and my program was not very supportive of trying to breastfeed, or of being a new parent in general. I had my 2nd baby as a 2nd year attending when I still had a salary guarantee and although I went into a small amount of "debt" (so I did not get a bonus that year, but over time made it back up so when I became a partner in my group, I didn't owe anything.) It was much better, but I was older and having a 2nd baby at 37 years old. I would not have wanted to wait to start my family then.

Only a truly toxic group will take issue with you being pregnant/newly postpartum and you don't want to be there anyway. I interviewed with my partners when I was 37 weeks pregnant. No hiding that from a bunch of obstetricians! However as someone else mentioned, FMLA does not kick in for a year and you may not be eligible for paid leave at all as an attending. Now, even though you do not qualify for FMLA doesn't mean your group won't grant you a decent maternity leave, but may be something to consider.

You do not now know what your attending job will look like, whether you will be able to take any paid leave, if so for how long, how long unpaid you can take, etc. You are still fairly young but in general with fertility, the sooner the better.

In terms of the demands of your schedule, pregnancy is different for every woman. I and my residency colleagues all worked full schedule/call until we delivered (I actually front-loaded my calls that year so when I came back after mat leave I didn't have to pay anyone back) and it was a non-issue. I wouldn't worry about being pregnant during fellowship. Being postpartum is another thing entirely - will you get adequate leave, and will you have to extend your training?

Above all be honest and up front with people - with your program director, Co-fellows, everyone. This is not to say you need to share the details of every pregnancy attempt but I recommend you tell your program (or job) by the end of the first trimester so plans can be made.

Good luck!

Perfectly presented. that's right, I just want to emphasize once again how important it is to plan everything and communicate in advance.